ICD-10 Common Codes. ICD-10 Code. ICD-10 Code. Diagnoses. Diagnoses

Size: px
Start display at page:

Download "ICD-10 Common Codes. ICD-10 Code. ICD-10 Code. Diagnoses. Diagnoses"

Transcription

1 Common s A63.8 Transmitted Diseases A64 A69.20 B00.9 B17.10 Acute Hepatitis C Without Hepatic Coma B18.1 Chronic Viral Hepatitis B Without Delta-Agent B18.2 Chronic Viral Hepatitis C B19.20 Coma B20 B34.9 B35.1 Tinea Unguium B37.3 Candidiasis Of Vulva And Vagina B89 Helicobacter Pylori (H. Pylori) As The Cause Of B96.81 Papillomavirus As The Cause Of Diseases B97.7 B99.9 C18.9 C20 Malignant Neoplasm Of Rectum C34.90 Malignant Neoplasm Of Upper-Outer Quadrant Of C C Right Female Breast C Left Female Breast C C C54.9 C56.1 Malignant Neoplasm Of Right Ovary C56.2 Malignant Neoplasm Of Left Ovary C56.9 C61 Malignant Neoplasm Of Prostate C67.9 C73 Malignant Neoplasm Of Thyroid Gland C79.51 Secondary Malignant Neoplasm Of Bone C79.52 Secondary Malignant Neoplasm Of Bone Marrow C85.80 C90.00 Multiple Myeloma Not Having Achieved Remission C91.10 Chronic Lymphocytic Leukemia Of B-Cell Type Not Having Achieved Remission C91.11 Chronic Lymphocytic Leukemia Of B-Cell Type In Remission C91.12 Chronic Lymphocytic Leukemia Of B-Cell Type In Relapse D12.6 D25.9 D47.2 Monoclonal Gammopathy D48.5 Neoplasm Of Uncertain Behavior Of Skin D49.2 D50.0 D50.8 D50.9 D51.0 D51.0 Soft Tissue, And Skin To Blood Loss (Chronic) D51.1 Selective Vitamin B12 Malabsorption With Proteinuria D51.2 D51.3 D51.8 D51.9 D53.9 D63.1 Anemia In Chronic Kidney Disease D63.8 Elsewhere D64.89 D64.9 Other Hemorrhagic Disorder Due To Intrinsic D Circulating Anticoagulants, Antibodies, Or Inhibitors D68.59 Other Primary Thrombophilia D68.9 D69.6 D70.9 D Page 1 of 8

2 Common s F90.0 F90.9 G35 G G G45.9 G47.00 G47.30 G60.9 Predominantly Inattentive Type Multiple Sclerosis Without Status Epilepticus Without Status Migrainosus Hereditary And Idiopathic Neuropathy, G89.29 Other Chronic Pain I10 Essential (Primary) Hypertension I11.9 Hypertensive Heart Disease Without Heart Failure Hypertensive Chronic Kidney Disease With Stage I12.9 I Through Stage 4 Chronic Kidney Disease, Or I20.9 Atherosclerotic Heart Disease Of Native Coronary I25.10 Artery Without Angina Pectoris Atherosclerotic Heart Disease Of Native Coronary I25.10 Artery I25.9 Other Pulmonary Embolism With Acute Cor I26.09 Pulmonale Other Pulmonary Embolism Without Acute I26.99 Cor Pulmonale I34.8 Other Nonrheumatic Mitral Valve Disorders I35.9 I42.8 Other Cardiomyopathy I48.91 I49.8 I49.9 I50.9 I51.9 I63.50 I65.29 Artery, Not Resulting In Cerebral Infarction I67.89 Other Cerebrovascular Disease I73.9 I I I82.90 I82.91 Phlebitis And Thrombophlebitis Of Other Deep Acute Embolism And Thrombosis Chronic Embolism And Thrombosis J00 Acute Nasopharyngitis (Common Cold) J01.90 J02.0 Streptococcal Pharyngitis J02.9 J03.90 J06.9 J18.9 J20.9 J30.1 Allergic Rhinitis Due To Pollen J30.89 Other Allergic Rhinitis J30.9 J31.0 Chronic Rhinitis J32.9 Chronic Obstructive Pulmonary Disease, J44.9 J K21.0 Esophagitis K21.9 Esophagitis K29.00 Acute Gastritis Without Bleeding K29.70 K29.9 K30 Functional Dyspepsia K31.9 Other Diseases Of Stomach And Duodenum K50.90 K K K K K Complications Bleeding With Intestinal Obstruction Complications Page 3 of 8

3 Common s D D72.89 E03.8 E03.9 E04.1 Nontoxic Single Thyroid Nodule E04.2 Nontoxic Multinodular Goiter E04.9 Thyrotoxicosis With Diffuse Goiter E05.00 Without Thyrotoxic Crisis Or Storm E05.90 Without Thyrotoxic Crisis Or Storm E06.3 Autoimmune Thyroiditis E07.9 E10.9 Type 1 Diabetes Mellitus Without Complications E11.21 Type 2 Diabetes Mellitus With Diabetic Nephropathy E11.22 Type 2 Diabetes Mellitus With Diabetic Chronic Kidney Disease E11.29 Type 2 Diabetes Mellitus With Other Diabetic Kidney Complication E11.40 Type 2 Diabetes Mellitus E11.41 E11.42 E11.43 E11.44 E11.49 E11.8 Type 2 Diabetes Mellitus With Other Diabetic Mononeuropathy Type 2 Diabetes Mellitus With Other Diabetic Polyneuropathy Type 2 Diabetes Mellitus With Other Diabetic Autonomic (Poly) Neuropathy Type 2 Diabetes Mellitus With Other Diabetic Amyotrophy Type 2 Diabetes Mellitus With Other Diabetic Neurological Complication Type 2 Diabetes Mellitus With E11.9 Type 2 Diabetes Mellitus Without Complications E16.2 E21.3 E28.2 Polycystic Ovarian Syndrome E29.1 Testicular Hypofunction E34.9 E53.9 E55.9 E56.9 E66.01 Morbid (Severe) Obesity Due To Excess Calories E66.2 Morbid (Severe) Obesity Due To Alveolar Hypoventilation E66.3 Overweight E66.9 E73.0 E73.1 E73.8 Other Lactose Intolerance E73.9 E74.31 E74.39 Other Disorders Of Intestinal Carbohydrate Absorption E78.0 Pure Hypercholesterolemia E78.1 Pure Hyperglyceridemia E78.2 Mixed Hyperlipidemia E78.5 E78.9 E83.10 E83.40 E83.51 Hypocalcemia E83.52 Hypercalcemia E86.0 Dehydration E87.1 Hypo osmolality And Hyponatremia E87.5 Hyperkalemia E87.6 Hypokalemia E87.8 Other Disorders Of Electrolyte And Fluid Balance, E88.81 Metabolic Syndrome E89.0 Postprocedural Hypothyroidism F11.20 Opioid Dependence, Uncomplicated F F25.9 F31.9 F32.9 Uncomplicated Major Depressive Disorder, Single Episode, F34.1 Dysthymic Disorder F41.1 Generalized Anxiety Disorder F41.9 F52.21 Male Erectile Disorder F52.22 Female Sexual Arousal Disorder Page 2 of 8

4 Common s K K51.90 K52.9 Complications Complications Noninfective Gastroenteritis And Colitis, Diverticulosis Of Large Intestine Without K57.30 Perforation Or Abscess Without Bleeding K58.0 Irritable Bowel Syndrome With Diarrhea K58.9 Irritable Bowel Syndrome Without Diarrhea K59.00 K62.5 Hemorrhage Of Anus And Rectum K63.5 Polyp Of Colon K72.10 Chronic Hepatic Failure Without Coma K72.11 Chronic Hepatic Failure With Coma K74.60 K75.9 K76.0 K76.9 K85.9 K92.1 Melena K92.2 L Abscess Of Lower Limb L02.91 L Cellulitis Of Lower Limb L03.90 Local Infection Of The Skin And Subcutaneous L08.9 L20.89 Other Atopic Dermatitis L25.9 Cause L30.9 L40.50 L40.8 Other Psoriasis L50.9 L65.9 L68.0 Hirsutism L70.8 Other Acne L72.3 Sebaceous Cyst Disorder Of The Skin And Subcutaneous Tissue, L98.9 M06.4 M06.9 M10.00 M10.9 M12.9 M13.0 M15.9 M19.90 M25.50 M M M Pain In Right Knee M Pain In Left Knee M M Pain In Right Ankle And Joints Of Right Foot M Pain In Left Ankle And Joints Of Left Foot M M32.9 M35.00 M35.3 Polymyalgia Rheumatica Systemic Involvement Of Connective Tissue, M35.9 M54.2 Cervicalgia M54.5 Low Back Pain M54.9 M60.9 Myositis M62.81 Muscle Weakness (Generalized) M Other Muscle Spasm M79.1 Myalgia M M80.00 Age-Related Osteoporosis With Current Age-Related Osteoporosis Without Current M81.0 Pathological Fracture M89.9 M94.9 N17.9 N18.1 Chronic Kidney Disease, Stage 1 N18.2 Chronic Kidney Disease, Stage 2 (Mild) Page 4 of 8

5 Common s N18.3 Chronic Kidney Disease, Stage 3 (Moderate) N18.4 Chronic Kidney Disease, Stage 4 (Severe) N18.9 N19 N20.0 Calculus Of Kidney N25.81 Secondary Hyperparathyroidism Of Renal Origin N28.9 N30.00 Acute Cystitis Without Hematuria N30.01 Acute Cystitis With Hematuria N30.90 N30.91 N36.9 Urethral Disorder N39.0 N39.9 Urinary System Disorder Enlarged Prostate Without Lower Urinary N40.0 Tract Symptoms (LUTS) N40.1 Enlarged Prostate With Lower Urinary Tract N41.9 N42.9 N52.9 N72 N76.0 Acute Vaginitis N76.89 N83.20 N83.29 Other Ovarian Cyst N87.0 Mild Cervical Dysplasia N89.8 N91.2 N92.0 N92.1 N92.1 N92.6 N94.6 N94.89 N94.9 Vagina Excessive And Frequent Menstruation With Regular Cycle Excessive And Frequent Menstruation Without Regular Cycle Excessive And Frequent Menstruation With Irregular Cycle Female Genital Organs And Menstrual Cycle Genital Organs And Menstrual Cycle N94.9 Genital Organs And Menstrual Cycle N95.0 Postmenopausal Bleeding N95.1 Menopausal And Female Climacteric States N95.2 Postmenopausal Atrophic Vaginitis N95.9 Disorder N97.9 O02.1 Missed Abortion O Supervision Of Other High-Risk Pregnancies, First Trimester O Supervision Of Other High-Risk Pregnancies, Second Trimester O Supervision Of Other High-Risk Pregnancies, Third Trimester O Supervision Of Other High-Risk Pregnancies, O09.90 O09.91 O09.92 Supervision Of High-Risk Pregnancy, Supervision Of High-Risk Pregnancy, O09.93 Third Trimester O20.0 Threatened Abortion O Abnormal Glucose Complicating Pregnancy P59.9 R00.0 R00.2 Palpitations R03.0 Elevated Blood Pressure Reading, Without Diagnosis Of Hypertension R05 Cough R06.02 Shortness Of Breath R06.89 Other Abnormalities Of Breathing R07.89 Other Chest Pain R07.9 R10.11 Right Upper Quadrant Pain R10.13 Epigastric Pain R10.31 Right Lower Quadrant Pain R10.32 Left Lower Quadrant Pain R10.84 Generalized Abdominal Pain R10.9 Page 5 of 8

6 Common s R11.0 Nausea R11.10 R11.2 R14.0 Abdominal Distention (Gaseous) R14.1 Gas Pain R14.2 Eructation R14.3 Flatulence R17 R19.7 R19.8 The Digestive System And Abdomen R20.0 Anesthesia Of Skin R20.1 Hypoesthesia Of Skin R20.2 Paresthesia Of Skin R20.3 Hyperesthesia R20.8 Other Disturbances Of Skin Sensation R20.9 R21 R25.2 Cramp And Spasm R30.0 Dysuria R31.0 Gross Hematuria R31.2 Other Microscopic Hematuria R31.9 R32 R35.0 Frequency Of Micturition R35.1 Nocturia R35.8 Other Polyuria R39.15 Urgency Of Urination R41.3 Other Amnesia R42 Dizziness And Giddiness R50.9 R51 Headache R53.81 Other Malaise R53.82 R53.83 Other Fatigue R55 Syncope And Collapse R56.9 R59.9 R60.9 R63.4 Abnormal Weight Loss R63.5 Abnormal Weight Gain R68.82 Decreased Libido R68.89 Other General Symptoms And Signs R73.01 Impaired Fasting Glucose R73.02 Impaired Glucose Tolerance (Oral) R73.09 Other Abnormal Glucose R73.9 R74.0 And Lactic Acid Dehydrogenase (LDH) R74.8 Abnormal Levels Of Other Serum Enzymes R76.9 Abnormal Immunological Finding In Serum, R79.89 R79.9 Chemistry Abnormal Finding Of Blood Chemistry, R80.9 R82.99 Other Abnormal Findings In Urine Atypical Squamous Cells Of Undetermined R US) Atypical Squamous Cells Cannot Exclude High Grade Squamous Intraepithelial Lesion On R Cytologic Smear Of Cervix (ASC-H) Low Grade Squamous Intraepithelial Lesion R On Cytologic Smear Of Cervix (LGSIL) R In Specimens From Cervix Uteri Cervical High-Risk Human Papillomavirus (HPV) R DNA Test Positive Abnormal Immunological Finding In Specimens R89.4 From Other Organs, Systems, And Tissues R94.31 Abnormal Electrocardiogram (ECG) (EKG) R94.5 Abnormal Results Of Liver Function Studies R94.6 Abnormal Results Of Thyroid Function Studies R97.20 T78.40XA T78.40XD T78.40XS T88.7XXA Medicament, Initial Encounter Page 6 of 8

7 Common s T88.7XXA Medicament, Sequela T88.7XXD Medicament, Subsequent Encounter Z00.00 Encounter For General Adult Medical Examination Without Abnormal Findings Z Encounter For Routine Child Health Examination Without Abnormal Findings Z Encounter For Gynecological Examination (General) (Routine) Without Abnormal Findings Z Encounter For Preprocedural Cardiovascular Examination Z Encounter For Other Preprocedural Examination Z02.0 Encounter Examination For Admission To Educational Institution Z02.1 Encounter For Pre-Employment Examination Z02.2 Encounter For Examination For Admission To Residential Institution Z02.3 Encounter For Examination For Recruitment To Armed Forces Z02.4 Encounter For Examination For Driving License Z02.5 Encounter For Examination For Participation In Sport Z02.6 Encounter For Examination For Insurance Purposes Z02.71 Encounter For Disability Determination Z02.79 Z02.81 Encounter For Paternity Testing Z02.82 Encounter For Adoption Services Z02.83 Encounter For Blood-Alcohol And Blood-Drug Test Z02.89 Encounter For Other Administrative Examinations Z08 Encounter For Follow-Up Examination After Completed Treatment For Malignant Neoplasm Encounter For Follow-Up Examination After Z09 Completed Treatment For Conditions Other Than Malignant Neoplasm Z11.3 Encounter For Screening For Infections With A Predominantly Sexual Mode Of Transmission Z11.51 Encounter For Screening For Human Papillomavirus (HPV) Z11.59 Encounter For Screening For Other Viral Diseases Z11.8 Encounter For Screening For Other Infectious And Parasitic Diseases Z11.9 Encounter For Screening For Infectious Z12.11 Of Colon Z12.12 Of Rectum Z12.4 Of Cervix Z12.5 Of Prostate Z12.72 Of Vagina Encounter For Screening For Diseases Of The Z13.0 Blood And Blood-Forming Organs And Certain Disorders Involving The Immune Mechanism Z13.1 Encounter For Screening For Diabetes Mellitus Z13.21 Encounter For Screening For Nutritional Disorders Z Encounter For Screening For Lipoid Disorders Z Encounter For Screening For Other Metabolic Disorders Z13.29 Encounter For Screening For Other Suspected Endocrine Disorder Z13.6 Encounter For Screening For Cardiovascular Disorders Z13.88 Encounter For Screening For Disorder Due To Exposure To Contaminants Z13.89 Encounter For Screening For Other Disorder Z13.9 Contact With And (Suspected) Exposure To Z20.2 Infections With A Predominantly Sexual Mode Of Transmission Z Contact With And (Suspected) Exposure To Other Viral Communicable Diseases Z20.9 Contact With And (Suspected) Exposure To Encounter For Other General Counseling And Z30.09 Advice On Contraception Z32.00 Encounter For Pregnancy Test, Result Unknown Z32.01 Encounter For Pregnancy Test, Result Positive Z33.1 Pregnant State, Incidental Z34.00 Encounter For Supervision Of Normal First Z34.80 Encounter For Supervision Of Other Normal Z36 Encounter For Antenatal Screening Of Mother Z39.2 Encounter For Routine Postpartum Follow-Up Z51.11 Encounter For Antineoplastic Chemotherapy Z51.81 Encounter For Therapeutic Drug Level Monitoring Z72.0 Tobacco Use Page 7 of 8

8 Common s Z72.51 High-Risk Heterosexual Behavior Z72.52 High-Risk Homosexual Behavior Z72.53 High-Risk Bisexual Behavior Z Contact With And (Suspected) Exposure To Lead Z77.21 Contact With And (Suspected) Exposure To Potentially Hazardous Body Fluids Z79.01 Long-Term (Current) Use Of Anticoagulants Z Other Long-Term (Current) Drug Therapy Z82.49 Family History Of Ischemic Heart Disease And Other Diseases Of The Circulatory System Z83.3 Family History Of Diabetes Mellitus Z94.0 Kidney Transplant Status Z94.4 Liver Transplant Status Z95.2 Presence Of Prosthetic Heart Valve For more information and resources, please visit SonoraQuest.com/ICD10 Sonora Quest Laboratories, the associated logo and marks are the registered trademarks of Sonora Quest Laboratories. All third party marks ' ' and ' ' are the property of their respective owners Sonora Quest Laboratories. All rights reserved Page 8 of 8

Premium Specialty: Pediatrics

Premium Specialty: Pediatrics Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium

More information

GLUCOSE TESTING-BLOOD

GLUCOSE TESTING-BLOOD 648.83 ABNORMAL GLUCOSE TOLERANCE COMPLICATING PREGNANCY, CHILDBIRTH OR THE PUERPERIUM, ANTEPARTUM CONDITION OR 648.84 ABNORMAL GLUCOSE TOLERANCE COMPLICATING PREGNANCY, CHILDBIRTH OR THE PUERPERIUM, POSTPARTUM

More information

DIGOXIN THERAPEUTIC DRUG ASSAY

DIGOXIN THERAPEUTIC DRUG ASSAY A18.84 Tuberculosis of heart E00.0 Congenital iodine-deficiency syndrome, neurological type E00.1 Congenital iodine-deficiency syndrome, myxedematous type E00.2 Congenital iodine-deficiency syndrome, mixed

More information

Fast Forward. ICD-9-CM Code ICD-10-CM Code(s) ICD-9-CM Code ICD-10-CM Code(s) 311 Depressive disorder, not elsewhere classified.

Fast Forward. ICD-9-CM Code ICD-10-CM Code(s) ICD-9-CM Code ICD-10-CM Code(s) 311 Depressive disorder, not elsewhere classified. Top 50 ICD-9-CM Code Code(s) ICD-9-CM Code Code(s) 789.00 Abdominal pain, unspecified site 311 Depressive disorder, not elsewhere classified R10.9 Unspecified abdominal pain. These include: R10.0 Acute

More information

GLUCOSE TESTING-BLOOD

GLUCOSE TESTING-BLOOD Abnormal glucose tolerance complicating pregnancy, childbirth or the 648.83 puerperium, antepartum condition or complication Abnormal glucose tolerance complicating pregnancy, childbirth or the 648.84

More information

FY 2011 WISEWOMAN Approved ICD-9 Code List

FY 2011 WISEWOMAN Approved ICD-9 Code List 243 Congenital hypothyroidism 245.0 Thyroiditis; Acute thyroiditis 245.1 Thyroiditis; Subacute thyroiditis 245.2 Thyroiditis; Chronic lymphocytic thyroiditis 245.3 Thyroiditis; Chronic fibrous thyroiditis

More information

BCCCP Approved ICD-9 Code List Fiscal Year 2010

BCCCP Approved ICD-9 Code List Fiscal Year 2010 BCCCP Approved ICD-9 List Fiscal Year 2010 Diagnosis Description 174.0 Malignant neoplasm of female breast; Nipple and areola 174.1 Malignant neoplasm of female breast; Central portion 174.2 Malignant

More information

FY 2016 MCRCEDP Approved ICD-10 Code List

FY 2016 MCRCEDP Approved ICD-10 Code List Approved List C18.0 Malignant neoplasm of cecum C18.1 Malignant neoplasm of appendix C18.2 Malignant neoplasm of ascending colon C18.3 Malignant neoplasm of hepatic flexure C18.4 Malignant neoplasm of

More information

0301 Anemia Others. Endocrine nutritional and metabolic disorders Others Vascular dementia and unspecified dementia

0301 Anemia Others. Endocrine nutritional and metabolic disorders Others Vascular dementia and unspecified dementia Certain infectious and parasitic diseases 0101 Intestinal infectious diseases 0102 Tuberculosis 0103 Infections with a predominantly sexual mode of transmission 0104 Viral infections characterized by skin

More information

APR-DRG Description Ave Charge

APR-DRG Description Ave Charge Abdominal Pain 16,500.25 2.8 6,000.09 Acute & Subacute Endocarditis 15,339.30 3.0 5,113.10 Acute Myocardial Infarction 17,687.46 2.6 6,802.87 Alcohol Abuse & Dependence 19,126.64 4.2 4,553.96 Alcoholic

More information

ICD-9-CM to ICD-10-CM DIAGNOSIS CODE MAPPING. Central Valley Public Health: Women's Way

ICD-9-CM to ICD-10-CM DIAGNOSIS CODE MAPPING. Central Valley Public Health: Women's Way ICD-9-CM to ICD-10-CM DIAGNOSIS CODE MAPPING Central Valley Public Health: Women's Way ICD-9-CM (Top 35) ICD-10-CM ICD-10-CM Description COMMENTS V10.3: Personal history of malignant neoplasm of Z85.3

More information

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty 666700 Acne Family Medicine, Internal Medicine, Pediatrics 438300 Acute Bronchitis Allergy,

More information

Non-covered ICD-10-CM Codes for All Lab NCDs

Non-covered ICD-10-CM Codes for All Lab NCDs Non-covered ICD-10-CM s for All Lab NCDs This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the test,

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Williams CM, Maher CG, Latimer J, et al. Efficacy

More information

Supplementary materials for:

Supplementary materials for: Supplementary materials for: Cecil E, Bottle A, Sharland M, Saxena S. Impact of UK primary care policy reforms on short-stay unplanned hospital admissions for children with primary care-sensitive conditions.

More information

ALBUMIN, SERUM I10 Essential (primary) hypertension

ALBUMIN, SERUM I10 Essential (primary) hypertension ALBUMIN, SERUM I10 Essential (primary) hypertension AMMONIA, PLASMA E72.2 Disorders of urea cycle metabolism (NEEDS 5 TH DIGIT) E72.21 Argininemia E72.22 Arginosuccinic aciduria E72.23 Citrullinemia E72.29

More information

ICD-10 Physician Education. General Surgery

ICD-10 Physician Education. General Surgery ICD-10 Physician Education General Surgery 1 Training Objectives ICD-9 to ICD-10 Comparison Documentation Tips Additional Educational Opportunities Questions 2 ICD-9 to ICD-10 Comparison Code Structure

More information

Asthma J45.20 Mild, uncomplicated J45.21 Mild, with (acute) exacerbation J45.22 Mild, with status asthmaticus

Asthma J45.20 Mild, uncomplicated J45.21 Mild, with (acute) exacerbation J45.22 Mild, with status asthmaticus A Fib & Flutter I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter Asthma J45.20 Mild, uncomplicated J45.21 Mild, with

More information

Episodes of Care Risk Adjustment

Episodes of Care Risk Adjustment Episodes of Care Risk Adjustment Episode Types Wave 1 Asthma Acute Exacerbation Perinatal Total Joint Replacement Wave 2 Acute Percutaneous Coronary Intervention COPD Acute Exacerbation Non-acute Percutaneous

More information

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health Patient Clinical Information Questionnaire 1.0 Date of Questionnaire Completion; / / 2.0 Patient Data 2.1 Name:

More information

Large Claimant Report

Large Claimant Report Description Group(s) LUBBOCK INDEPENDENT SCHOOL DISTRICT Date Run 10/4/20 Claim Source: Non Rx Claims Table - Medical Threshold: 50000 Large Claimant Report Period Paid: 1/20-10/20 Fill: 1/20-10/20 Large

More information

Ultrasound ICD-10-CM

Ultrasound ICD-10-CM Ultrasound ICD-10-CM Clinical Documentation Guides Brought to you by www.codingstrategies.com The Resource for Physician and Outpatient Coding, Compliance & ICD-10-CM OTHER CLINICAL DOCUMENTATION GUIDES

More information

Using 3-Digit ICD-9-CM Codes with the Elixhauser Comorbidity Index

Using 3-Digit ICD-9-CM Codes with the Elixhauser Comorbidity Index Congestive Heart Failure 398.91 Rheumatic heart failure (congestive) 398 Other rheumatic heart disease 402.01, 402.11, 402.91 402 Hypertensive heart disease 404.01, 404.03, 404.11, 404.13, 404.91, 404.93

More information

US ARMY Public Health Command

US ARMY Public Health Command US ARMY Public Health Command Morbidity Burdens, Army Non-Active Duty Beneficiaries, 2012 Photo graphic using models Approved for public release; distribution unlimited. ii TABLE OF CONTENTS BACKGROUND...1

More information

Cardiology/Cardiothoracic

Cardiology/Cardiothoracic Cardiology/Cardiothoracic ICD-9-CM to ICD-10-CM Code Mapper 800-334-5724 www.contexomedia.com 2013 ICD-9-CM 272.0 Pure hypercholesterolemia 272.2 Mixed hyperlipidemia 272.4 Other and hyperlipidemia 278.00

More information

155.2 Malignant neoplasm of liver not specified as primary or secondary. C22.9 Malignant neoplasm of liver, not specified as primary or secondary

155.2 Malignant neoplasm of liver not specified as primary or secondary. C22.9 Malignant neoplasm of liver, not specified as primary or secondary ICD-9 TO ICD-10 Reference ICD-9 150.9 Malignant neoplasm of esophagus unspecified site C15.9 Malignant neoplasm of esophagus, unspecified 151.9 Malignant neoplasm of stomach unspecified site C16.9 Malignant

More information

Non-covered ICD-10-CM Codes for All Lab NCDs

Non-covered ICD-10-CM Codes for All Lab NCDs Non-covered ICD-10-CM s for All Lab NCDs This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the test,

More information

Attending Physician s Statement

Attending Physician s Statement ( Form A A This form is used for claiming the social insurance benefit. This form should be completed and signed by the attending physician outpatient and One form for each month, one form for hospitalization

More information

NEW GYN PATIENT HISTORY FORM (OB PATIENTS, please DO NOT USE THIS FORM. Thanks.)

NEW GYN PATIENT HISTORY FORM (OB PATIENTS, please DO NOT USE THIS FORM. Thanks.) NEW GYN PATIENT HISTORY FORM (OB PATIENTS, please DO NOT USE THIS FORM. Thanks.) TODAY'S DATE Your age DATE OF BIRTH YOUR NAME (Last) (First) (M.I.) REFERRED HERE BY YOUR PAST MEDICAL HISTORY (If YOU have

More information

SUPPLEMENTARY MATERIAL

SUPPLEMENTARY MATERIAL SUPPLEMENTARY MATERIAL Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records Riccardo Miotto 1,2, Li Li 1,2, Brian A. Kidd 1,2, and Joel T. Dudley

More information

Lipids Testing

Lipids Testing Previously Listed as Edit 12 190.23 - Lipids Testing Lipoproteins are a class of heterogeneous particles of varying sizes and densities containing lipid and protein. These lipoproteins include cholesterol

More information

PATIENT HEALTH QUESTIONNAIRE Radiation Oncology

PATIENT HEALTH QUESTIONNAIRE Radiation Oncology REVIEWED DATE / INITIALS Safety: Are you at risk for falls? Do you have a Pacemaker? Females; Is there a possibility you may be pregnant? Allergies: If YES, please list medication allergies: Do you have

More information

University Gynecologic Oncology Associates

University Gynecologic Oncology Associates University Gynecologic Oncology Associates Medical History Form Date: Name: Date of Birth: / / GYNE HISTORY Age of first period? If you no longer have periods, at what age did they stop? Are you pregnant

More information

PATIENT HEALTH QUESTIONNAIRE Radiation Oncology

PATIENT HEALTH QUESTIONNAIRE Radiation Oncology REVIEWED DATE / INITIALS Safety: Yes No Are you at risk for falls? Do you have a Pacemaker? Females; Is there a possibility you may be pregnant? Allergies: Yes No If YES, please list medication allergies:

More information

SCOPE OF PRACTICE. HEMATOLOGY and ONCOLOGY. -ordering / interpreting / performing appropriate diagnostic tests

SCOPE OF PRACTICE. HEMATOLOGY and ONCOLOGY. -ordering / interpreting / performing appropriate diagnostic tests SCOPE OF PRACTICE HEMATOLOGY and ONCOLOGY Care of the patients shall include, but not be limited to: -Performance of an appropriate history and physical exam -ordering / interpreting / performing appropriate

More information

Adult Health History

Adult Health History Patient Name Date of Birth Adult Health History This form will assist us in obtaining a complete medical history and health record on you. By completing this ahead of time it will also simply your visit

More information

PLEASE COMPLETE ALL SECTIONS OF THIS FORM

PLEASE COMPLETE ALL SECTIONS OF THIS FORM PLEASE COMPLETE ALL SECTIONS OF THIS FORM Patient Name: Date of Birth: Referring Doctor? (Name, telephone number and address) Chief Complaint: Why have you come here? How did it start? What are the symptoms?

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

2014 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 84436, 84439, 84443, THYROID TESTING DESCRIPTION

2014 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 84436, 84439, 84443, THYROID TESTING DESCRIPTION 017.50-017.56 Tuberculosis of the thyroid gland 183.0 Malignant neoplasm of ovary 193 Malignant neoplasm of thyroid gland 194.8 Malignant neoplasm of other endocrine glands and related structures 198.89

More information

ETG Analyzer Report. Your Practice # Episodes. Mkt Share Mkt Volume WHIO Dermatology 575 Acne 746 $508 1,698 $

ETG Analyzer Report. Your Practice # Episodes. Mkt Share Mkt Volume WHIO Dermatology 575 Acne 746 $508 1,698 $ ETG Analyzer Report Practice: Practice Group: Badger County Severity: Level 1 Payers: Commercial Episode Types: Complete Claims: Full Claims Outliers: No Outliers DMV6 Created: April 1, 2010 March 31,

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

Review of Systems NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient,

Review of Systems NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient, LOS ANGELES CANCER NETWORK NEW PATIENT HEALTH QUESTIONNAIRE NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient, In order to offer optimal care for you, we need to understand your complete health status

More information

Non-covered ICD-10-CM Codes for All Lab NCDs

Non-covered ICD-10-CM Codes for All Lab NCDs Non-covered ICD-10-CM Codes for All Lab NCDs This section lists codes that are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the

More information

BACTERIAL CULTURE, URINE

BACTERIAL CULTURE, URINE 789.00-789.09 ABDOMINAL PAIN 789.60-789.69 ABDOMINAL TENDERNESS 276.2 ACIDOSIS 570 ACUTE AND SUBACUTE NECROSIS OF LIVER 580.0-580.9 ACUTE GLOMERULONEPHRITIS 780.97 ALTERED MENTAL STATUS V44.50-V44.6 ARTIFICIAL

More information

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency

More information

Gastroenterology. Certification Examination Blueprint. Purpose of the exam

Gastroenterology. Certification Examination Blueprint. Purpose of the exam Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

Patient Name Date of Birth Age. Other phone ( ) . Other

Patient Name Date of Birth Age. Other phone ( )  . Other GASTROINTESTINAL & MINIMALLY INVASIVE SURGERY HEALTH HISTORY QUESTIONNAIRE Date Patient Name _ Date of Birth Age Daytime phone ( ) Other phone ( ) Email How did you hear about us? My doctor Yellow pages

More information

DATA REQUEST RESPONSE- XRT AND BRACHYTHERAPY

DATA REQUEST RESPONSE- XRT AND BRACHYTHERAPY Date: 10 th April 2018 DATA REQUEST RESPONSE- XRT AND BRACHYTHERAPY Request: 1. Utilization Data of Overseas Beam Therapy and Brachytherapy 2. Diagnoses Data of Overseas Claims for Beam Therapy and Brachytherapy

More information

ENROLLMENT : Line of Business Summary

ENROLLMENT : Line of Business Summary ENROLLMENT : Line of Business Summary Date Range : JAN 2017 through DEC 2017 COMPREHENSIVE MAJOR MEDICAL Print Date : 1/19/2018 9:43:49AM Page 1 of 1 Month Year Single 2 Person : Emp/Spouse 2 Person :

More information

DRG Code DRG Description FY18 Average Charge

DRG Code DRG Description FY18 Average Charge DRG Code DRG Description FY18 Average Charge 3 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O $ 665,511 4 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $ 422,497 37 EXTRACRANIAL

More information

S2 File. Clinical Classifications Software (CCS). The CCS is a

S2 File. Clinical Classifications Software (CCS). The CCS is a S2 File. Clinical Classifications Software (CCS). The CCS is a diagnosis categorization scheme based on the ICD-9-CM that aggregates all diagnosis codes into 262 mutually exclusive, clinically homogeneous

More information

ICD-10 Physician Education. Palliative Care SIP

ICD-10 Physician Education. Palliative Care SIP ICD-10 Physician Education Palliative Care SIP 1 Training Objectives ICD-9 to ICD-10 Comparison Documentation Tips Additional Educational Opportunities Questions 2 ICD-9 to ICD-10 Comparison Code Structure

More information

Who is filling out this intake form? Self Spouse Parent Guardian

Who is filling out this intake form? Self Spouse Parent Guardian Office Use Only: Reviewed with Patient Data Entry Scan & File Date: Date: Date: Initials: Initials: Initials: Today s Date: Who is filling out this intake form? Self Spouse Parent Guardian If you are not

More information

CMS Limitations Guide - Cardiovascular Services

CMS Limitations Guide - Cardiovascular Services CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

Diagnosis-specific morbidity - European shortlist

Diagnosis-specific morbidity - European shortlist I Certain infectious and parasitic diseases 1 Tuberculosis A15-A19 X X Z 2 Sexually transmitted diseases (STD) A50-A64 Y Z 3 Viral hepatitis (incl. hepatitis B) B15-B19 X Z 4 Human immunodeficiency virus

More information

RECOMMENDED COURSE ORDER

RECOMMENDED COURSE ORDER Although you have the flexibility to view the videos in any order, we strongly recommend that you watch the videos in the order in which your dashboard presents them regardless of how many videos you view

More information

PREAMBLE GENERAL DIAGNOSTIC RADIOLOGY

PREAMBLE GENERAL DIAGNOSTIC RADIOLOGY PREAMBLE The General Diagnostic Radiology category is intended to cover the body of knowledge a practicing board certified Diagnostic Radiologist should know. Since the range of content relevant to the

More information

2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82728, 83540, 83550, IRON - SERUM

2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82728, 83540, 83550, IRON - SERUM 790.01-790.09 ABNORMALITY OF RED BLOOD CELLS 572.0 ABSCESS OF LIVER 570 ACUTE AND SUBACUTE NECROSIS OF LIVER 207.02 ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, IN RELAPSE 207.00-207.01 ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA,

More information

Patient #1 A Spouse $534,946.73

Patient #1 A Spouse $534,946.73 Shock Loss Report MM & RX Combined PUNBR: 002 GRNBR: 248 Warning Amount: 100000 Over Amount: 200000 Incurred MM 1/1/2014 through 12/31/2016 PaidMM 1/1/2016 through 12/31/2016 Incurred RX 12/16/2015 through

More information

NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C.

NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C. NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C. Past Medical History AIDS/HIV disease Anemia Asthma Bronchitis Cancer Date of last Chest X-ray Diabetes Mellitus, Type I Diabetes Mellitus,

More information

Table of Contents. Course CME Credits. General Principles Topic CME Credit(s)

Table of Contents. Course CME Credits. General Principles Topic CME Credit(s) Table of Contents Course Course CME Credits Med-Challenger SPEX Comprehensive Review 266.0 CME Credits General Principles 21.0 CME Credit(s) Abdominal Pain 1.0 Acute Pelvic Pain in Women 1.0 Acute Vaginal

More information

HCPCS Codes (Alphanumeric, CPT AMA) ICD-9-CM Codes Covered by Medicare Program

HCPCS Codes (Alphanumeric, CPT AMA) ICD-9-CM Codes Covered by Medicare Program HCPCS s (Alphanumeric, CPT AMA) 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening ICD-9-CM

More information

MEDICAL HISTORY FORM FOR FOLLOW-UP

MEDICAL HISTORY FORM FOR FOLLOW-UP MEDICAL HISTORY FORM FOR FOLLOW-UP ID NUMBER: 0a) Form Date... / / 0b) Staff Code... Instructions: Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost

More information

Welcome to About Women by Women

Welcome to About Women by Women Welcome to About Women by Women Today s Date New Patient Questionnaire Name: Birth Date: / / Home Phone: Address: Cell Phone: Work Phone: Occupation: Employer: Marital Status: Married Living w/ Partner

More information

NCD for Fecal Occult Blood Test

NCD for Fecal Occult Blood Test NCD for Fecal Occult Blood Test Applicable CPT Code(s): 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal

More information

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE. Cranial Health History Form

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE. Cranial Health History Form WASHINGTON UNIVERSITY SCHOOL OF MEDICINE Cranial Health History Form Welcome to the Neurosurgery Department at Washington University. To help us treat you, please fill this form out completely. Your Name:

More information

Jeri Shuster, M.D., P.A.

Jeri Shuster, M.D., P.A. Please help us to help you by completing this health history form. We will review together at your first visit. Included is potentially relevant Ob-Gyn, Medical, Surgical, and pertinent family history.

More information

Emergency Medicine Scope of Practice

Emergency Medicine Scope of Practice Emergency Medicine Scope of Practice All Physician Assistants working in Emergency Medicine will encounter a wide variety of non acute, urgent and emergent patient complaints and conditions. Given the

More information

PLEASE LET US KNOW YOUR REASON FOR TODAY S VISIT : CURRENT MEDICATIONS (WITH DOSAGE) PLEASE INCLUDE VITAMINS AND HERBAL MEDICATIONS:

PLEASE LET US KNOW YOUR REASON FOR TODAY S VISIT : CURRENT MEDICATIONS (WITH DOSAGE) PLEASE INCLUDE VITAMINS AND HERBAL MEDICATIONS: 1 NAME: DATE OF BIRTH PLEASE LET US KNOW YOUR REASON FOR TODAY S VISIT : CURRENT MEDICATIONS (WITH DOSAGE) PLEASE INCLUDE VITAMINS AND HERBAL MEDICATIONS: PAST MEDICAL HISTORY (YOUR MEDICAL HISTORY) :

More information

(unintentional) (of), endocrine system organ or structure, during procedure on other organ.

(unintentional) (of), endocrine system organ or structure, during procedure on other organ. 1. A 7 month old male was brought in by his mother who states that he has been coughing for the past 10 days but she has noticed an increased severity in the coughing today with a noticeable high pitched

More information

Wisconsin Longitudinal Study Codebook. Information about the Graduate Spouse s current marriage was collected in the following manner:

Wisconsin Longitudinal Study Codebook. Information about the Graduate Spouse s current marriage was collected in the following manner: Phone: Marriage HMARR - Marriage Module Graduate-Spouse Phone Instrument OVERVIEW Information about the Graduate Spouse s current marriage was collected in the following manner: -Information about the

More information

Northeast Ohio Urogynecology Patient History Intake Form. Last Name First Name Age. Date of Birth Race Referring Physician.

Northeast Ohio Urogynecology Patient History Intake Form. Last Name First Name Age. Date of Birth Race Referring Physician. Northeast Ohio Urogynecology Patient History Intake Form Last Name _First Name Age_ Date of Birth Race Referring Physician Reason for Visit: _ Allergies: Preferred Lab (circle): QUEST LABCARE PLUS LABCORP

More information

Medical PANRE. Physician Assistant National Recertifying Exam.

Medical PANRE. Physician Assistant National Recertifying Exam. Medical PANRE Physician Assistant National Recertifying Exam https://killexams.com/pass4sure/exam-detail/panre Question: 60 A patient comes to the office presenting with paroxysmal or sustained hypertension,

More information

Patient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children?

Patient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children? PH NEW PATIENT HISTORY Patient Name Date of Birth MALE / FEMALE Date Occupation: Left handed or Right handed Marital Status: Single Married Divorced Widowed Children? Y or N # Previous Treating Physician:

More information

NCD for Serum Iron Studies

NCD for Serum Iron Studies NCD for Serum Iron Studies Applicable CPT Code(s): 82728 Ferritin 83540 Iron 83550 Iron Binding capacity 84466 Transferrin ICD-9 Codes that Support Medical Necessity: Code Description 790.01-790.09 Abnormality

More information

Prioritized ShortList MORBIDITY

Prioritized ShortList MORBIDITY Report on in-depth analysis of pilot studies in 16 Member States on diagnosis-specific morbidity statistics Annex 2 (Rev 11_11_13) Prioritized ShortList MORBIDITY Legend: X recommended for collection Y

More information

TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM

TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM TEXAS VASCULAR ASSOCIATES, P.A. PATIENT CLINICAL INTAKE FORM PATIENT NAME: DATE OF BIRTH: TVA Physician being seen: Date of Visit: PAST MEDICAL HISTORY HEART PROBLEMS NEUROLOGICAL Congestive Heart Failure

More information

CONTENTS 1. PUBLIC HEALTH ISSUES 2. SIGNS AND SYMPTOMS 3. DIAGNOSTIC TESTS 4. CARDIOVASCULAR DISEASES 5. RESPIRATORY DISEASES

CONTENTS 1. PUBLIC HEALTH ISSUES 2. SIGNS AND SYMPTOMS 3. DIAGNOSTIC TESTS 4. CARDIOVASCULAR DISEASES 5. RESPIRATORY DISEASES CONTENTS 1. PUBLIC HEALTH ISSUES 2. SIGNS AND SYMPTOMS 3. DIAGNOSTIC TESTS 4. CARDIOVASCULAR DISEASES 5. RESPIRATORY DISEASES 6. GASTROINTESTINAL DISEASES 7. UROGENITAL DISEASES 8. SEXUALLY TRANSMITTED

More information

SHMI diagnoses July 2016 to June 2017

SHMI diagnoses July 2016 to June 2017 SHMI diagnoses July 2016 to June 2017 0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 Pneumonia (except that caused by tuberculosis or sexually transmitted disease) Acute cerebrovascular disease Septicaemia

More information

Your Name: Date of Birth: Age: Address: City/State/Zip: Phone (home): (mobile): (work): Shall we add you to our e-newsletter?

Your Name: Date of Birth: Age: Address: City/State/Zip: Phone (home): (mobile): (work):   Shall we add you to our e-newsletter? Your Name: Date of Birth: Age: Address: City/State/Zip: _ Phone (home): (mobile): (work): Email: Shall we add you to our e-newsletter? Y / N Your Employer: Employer Phone: Employer Address: Your Occupation:

More information

CPT Codes: The following ICD-10-CM codes support the medical necessity of CPT code 82306:

CPT Codes: The following ICD-10-CM codes support the medical necessity of CPT code 82306: CPT s: 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed 82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed The following ICD-10-CM codes support the medical necessity of

More information

DOB: / / Please list the names and telephone numbers of the other physicians involved in your care: Name Specialty Phone Address Receive Report (Y/N)

DOB: / / Please list the names and telephone numbers of the other physicians involved in your care: Name Specialty Phone Address Receive Report (Y/N) Medical History: Patient: DOB: / / Please list the names and telephone numbers of the other physicians involved in your care: Name Specialty Phone Address Receive Report (Y/N) List the names of prescription

More information

Internal Medicine End of Rotation

Internal Medicine End of Rotation Internal Medicine End of Rotation EXAM TOPIC LIST CARDIOVASCULAR Angina pectoris Cardiac arrhythmias/conduction disorders Cardiomyopathy Congestive heart failure Coronary vascular disease Endocarditis

More information

Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1

Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1 Appointment Date: Page 1 Chief Complaint: (Please write reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History PERSONAL SKIN HISTORY YES NO Yes - Details Melanoma

More information

A Review of FDA PRO Labeling ( ) Ari Gnanasakthy RTI Health Solutions

A Review of FDA PRO Labeling ( ) Ari Gnanasakthy RTI Health Solutions A Review of FDA PRO Labeling (2011-2015) Ari Gnanasakthy RTI Health Solutions SEVENTH ANNUAL PATIENT-REPORTED OUTCOME (PRO) CONSORTIUM WORKSHOP April 27-28, 2016 Silver Spring, MD Disclaimer The views

More information

Patient Interview Form

Patient Interview Form Page 1 of 5 Patient Interview Form Patient Information First Name: MRN: Last Name: Date Of Birth: Contact Preference Email Telephone call- Work Telephone call - Home Email Please check one as your preferred

More information

Evolve180 / Ideal Northwest Health Profile

Evolve180 / Ideal Northwest Health Profile Evolve180 / Ideal Northwest Health Profile ABOUT YOU First Name: Last Name: Address: City: State: Zip: Phone: Email: Date of Birth: Age: Height: Occupation: How did you find out about our program? Marital

More information

Vitamin D Assay Testing For services performed on or after

Vitamin D Assay Testing For services performed on or after 2018 MEDICARE LOCAL COVERAGE DETERMINATION (LCD) - L36692 CPT CODES: 82306, 82652 Vitamin D Assay Testing For services performed on or after 2-3-2017 DLS TEST CODE AND NAME 49907 (1,25 DIHYDROXY) (CPT

More information

Name: Today s Date: Address: State, Zip Code

Name: Today s Date: Address: State, Zip Code New Patient Health History Questionnaire Name: Today s Date: Address: City State, Zip Code Email Address: Date of Birth: Home Telephone #: Cell Number: Work Number: Emergency Contact name & number: Referred

More information

ANY FAMILY HISTORY OF ANEURYSM OR DVT?

ANY FAMILY HISTORY OF ANEURYSM OR DVT? NAME: D/O/B: DATE: MR# WHAT PROBLEM(S) BRINGS YOU HERE TODAY? WHO SENT YOU TO US? DOCTOR/OTHER WHICH DOCTOR? WHAT SURGERY HAVE YOU HAD AND WHEN? (LIST) 1. 2. 3. 4. 5. 6. 7. HOW MUCH ALCOHOL DO YOU DRINK

More information

TN Bundled Payment Initiative: Overview of Episode Risk Adjustment

TN Bundled Payment Initiative: Overview of Episode Risk Adjustment TN Bundled Payment Initiative: Overview of Episode Risk Adjustment United Healthcare, April 2014 The State of Tennessee has implemented an episode-based approach to reimburse providers for the care delivered

More information

PATIENT INFORMATION FORM (WOMEN ONLY)

PATIENT INFORMATION FORM (WOMEN ONLY) PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for

More information

MEDICAL FACULTY DEPARTMENT OF PATHOPHYSIOLOGY QUESTION FOR ORAL PART OF EXAM MEDICAL STUDENTS

MEDICAL FACULTY DEPARTMENT OF PATHOPHYSIOLOGY QUESTION FOR ORAL PART OF EXAM MEDICAL STUDENTS MEDICAL FACULTY DEPARTMENT OF PATHOPHYSIOLOGY QUESTION FOR ORAL PART OF EXAM MEDICAL STUDENTS GENERAL PART (1 question) 1. Health and disease as a dynamic process 2. Stages of the disease development 3.

More information

Pharmacotherapy Handbook

Pharmacotherapy Handbook Pharmacotherapy Handbook Eighth Edition Barbara G. Wells, PharmD, HP, FCCP, BCPP Dean and Professor Executive Director, Research Institute of Pharmaceutical Sciences School of Pharmacy, The University

More information

VASCULAR SURGERY PATIENT HEALTH HISTORY

VASCULAR SURGERY PATIENT HEALTH HISTORY VASCULAR SURGERY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications? To

More information

In the August 2016 issue of OBG Management,

In the August 2016 issue of OBG Management, GYN coding changes to note for your maximized reimbursement Revised ICD-10 gynecologic diagnostic codes go into effect October 1. Here is a look at the added, expanded, and revised codes you will need

More information

John Wayne Cancer Institute Dr. Foshag Dr. Faries Dr. Bilchik Dr. Leuchter

John Wayne Cancer Institute Dr. Foshag Dr. Faries Dr. Bilchik Dr. Leuchter John Wayne Cancer Institute Dr. Foshag Essner Dr. Fischer Dr. Faries Dr. Foshag Dr. Bilchik Dr. O'Day Dr. Leuchter Medical Questionnaire Reset Form Date: Name: Gender: Male Female Age: Last First Middle

More information

Medical Questionnaire

Medical Questionnaire MEDICIS Health Testing Center Avenue de Tervueren 236 115 Bruxelles Tel : 2/762.5.44 Medical Questionnaire Name :. Maiden name : First name :. Sex :. Address :...... Phone (private) : Office :. Date of

More information

725 Jesse Jewell Pkwy, Suite 390 Gainesville, GA (770) (770) (facsimile)

725 Jesse Jewell Pkwy, Suite 390 Gainesville, GA (770) (770) (facsimile) Charles Nash, III, M.D., F.A.C.P. Richard J. LoCicero, M.D. Anup K. Lahiry, M.D. Timothy M. Carey, M.D. Andrew Johnson, M.D. 725 Jesse Jewell Pkwy, Suite 390 Gainesville, GA 30501 (770) 297-5700 (770)

More information